P - 81589��' ' REQUEST FOR ELECTRICAL INSPECTION ,-��:� ..
6�G�� O� � Minnesota State Board of Electricity
� ea 1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800 "�'
° Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this reqvest. Enter remarks in this space and on the back of the white copy only.
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Calculate Inspection Fee - This Inspection Request will noi be accepted without the correct fee:
Other Fee # Service Entrance S' Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 00 Amps Q 0 to 100 Amps
Street Ltg./TrafFic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTA�, 4, _
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
elecfrical installation dexribed herein on the dates sfafed
' ' Final Ua
Investigative Fee 2. � z 7"Q=
THIS INSTALLATION MAY BE ORDERED DISCONNEC D IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 monfhs from validafion dafe prinfed in ihis box.
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PLEASE PRINT OR TYPE `�
�R uesf Date Rough-in �inspecfion required$ ❑ Yes �No Inspecfion Other Than Rough-In: ❑ Ready Now�Will Call
� ��� �You must call fhe inspector when ready) Date Ready:
I, �licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sfreet, Box, or Rou� o.) City Zip Code
3 — s�.� ,�. ,�
Secfion No. Township Name or No. Range No. Fire o. ouny �
Occupanf /1(
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28��fi
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Phone No.
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�onhacror (Compan Na e) Conkacror license No. Master Lic. No.
G`lP� �/-.« �G ,�L/ G � �fT D��7'�
ddress (Conhactor or Owner P rforming Insfallafion� /' � / �,� � C
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Phone No.
1 1 8/96 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY